tv The David Rubenstein Show Peer to Peer Conversations Bloomberg January 28, 2018 5:00am-5:30am EST
♪ david: what was the human genome project? dr. collins: it is basically the entire instruction book for an organism. david: was it harder to discover the human genome or be appointed by two different presidents? dr. collins: both of those had certain challenges. david: how much longer do you think people can keep increasing their longevity? dr. collins: we might figure out how to achieve that by tinkering with the biology. david: what is the single greatest health challenge the united states faces today? dr. collins: more people died of opioid overdoses than car wrecks last year. it is just unbelievable. >> would you fix your tie, please? david: well, people wouldn't recognize me if my tie was fixed, but ok. just leave it this way. alright. ♪
david: i don't consider myself a journalist. and nobody else would consider myself a journalist. i began to take on the life of being an interviewer even though i have a day job of running a private equity firm. how do you define leadership? what is it that makes somebody tick? ♪ david: dr. collins, thank you very much for taking time with us today. you are the 16th director of the nih. you are the only person who was appointed by two different presidents, initially by president obama and subsequently by president trump. as a person who co-discovered the human genome, was it harder to discover the human genome or be appointed by two different presidents? dr. collins: i guess both of those had certain challenges associated. i did not expect to still be in this position after january 2017 because i knew about the history too. nih directors appointed by the president, virtually always have turned over when there is a new
president. somehow they made a mistake here, i guess, and kept me on. david: did president trump say he knew you did a great job, or how did that come about? dr. collins: i got a call saying we want you to come to new york and meet with trump at trump tower a few days before the inauguration so he can talk to you and get a sense of whether you are somebody he might want to keep on, so i went in. david: so you went to trump tower? dr. collins: i did. david: you seem to be a man of simple tastes. i suspect you are not a big shopper in trump tower stores before? dr. collins: i had not been there before. you are quite right. i rode the bus from washington to new york for my interview. i suspect i may be the only person who rode the bus to an interview at trump tower, but there you go. david: i'm sure that is true. how was the interview? dr. collins: i had less than half an hour with the president-elect for him to ask me some questions. a few other people in the room, also, so i wasn't sure how it had gone. i showed up. i did the best i could to answer those questions and waited to see what would happen.
david: so the country is relieved, i think, you have the job. you mentioned your family. you were raised on a farm more or less, is that right? dr. collins: i was. david: you were homeschooled. dr. collins: homeschooled, not because my parents were really is in their persuasion at all, but because they thought the county schools where i grew up in the shenandoah valley of virginia were not up to my parents' standards. my mother was incredibly gifted as a teacher, and she figured out early on how to get the process of learning to be something wonderfully exciting, and that is the gift she gave me and my brothers, this excitement about learning new things, which i carry with me to this day. david: you did this until the sixth grade? dr. collins: yeah. david: and then you went to school? dr. collins: i think my mom was a little tired of teaching these four boys and figured, ok, public schools in the city of stanton are maybe up to a better standard, so i started going to public school. david: you were a musician as well. you had a band. how did you come to that? dr. collins: my dad was trained as a classical violinist.
he and my mom met at yale, they went and worked for eleanor roosevelt in the depths of the depression in west virginia trying to help coal miners get back on their feet. my dad fell in love with the traditional music that the coal miners would play, particularly on the fiddle. we did not have a television. what did you do after dinner at the farm? either my dad would read charles dickens out loud, or we would play. if you wanted to be in the family, you better learn to play something. david: did famous musicians come over to your house? dr. collins: people would drop by. perhaps the best known, although not at the time, was a sullen 18-year-old who showed up, brought along by a more senior, experienced folksong writer and singer. the young 18-year-old turned out was having his birthday in our living room. he sang a few songs and had a terrible voice and no social skills, and i was quite sure he had no future at all. that of course turned out to be
bob dylan. david: did you ever meet him again? dr. collins: i did. david: did he remember you? dr. collins: no. he denies the whole thing. it was quite a bit later, maybe 10 years ago. david: you went to college, the university of virginia. dr. collins: yes. david: were you an academic superstar there? dr. collins: i was a bit of a nerd. i got excited about science in high school. i should give testimony right now to the importance of having really good teachers in high school. what got me interested from science did not come from my family. no scientists or physicians. for generations. it was that course i had in 10th grade at lee high school. david: you then went to yale to get a phd in what? dr. collins: in chemical physics. david: what is chemical physics? dr. collins: quantum mechanics, mathematical, physical science. david: your parents were proud. you got a degree from the university of virginia. you have a phd from yale, and now you're ready to get a job, right? dr. collins: you would think so, wouldn't you? [laughter] david: what happened?
dr. collins: here i was as a graduate student working late at night, and there was another guy a floor above me working in the lab on dna. the more i read about it and talked to him about it and began to read articles about it, the more excited i got. this is an area of science that is ready to burst forward with all kinds of potential. and frankly, i was feeling a little bit lonely and like what i was pursuing in terms of quantum mechanics and second-order differential equations that nobody could solve, maybe that was not going to be my way of making the world a really much better place, and maybe there was something else i could do. david: so you got your medical degree? dr. collins: i was trying to figure out how i put this all together as a medical student, my appreciation and love for digital information and for mathematics, which is what i got out of chemistry and physics, with this messy thing called medicine? where does it all come together? in genetics. dna is digital information. it is something you can compute on. david: ok. dr. collins: it also is fundamental to life and medicine. so by the time i was halfway
through my first year as a medical student, i knew i wanted to be a geneticist. david: let me talk a little bit about something you did that brought you to national fame and attention, and that is the human genome project. what was the human genome project, and why do we care about you having co-discovered it? dr. collins: good question. what is the genome anyway? basically, it is the entire construction book, which is written in the language of dna for an organism, so we humans have a genome, and so do other living organisms, plants, animals. bacteria. they all have a genome. ours is pretty big. if you think of dna as a language, it is an interesting one. it has just four letters in its alphabet, which we call a,c, g, and t. they are abbreviations for chemical bases. our genomes are 6 billion of those letters. you get 3 billion from mom and 3 billion from dad. that is a lot. although it is pretty amazing to contemplate that that is a bounded set of information, and that seems to be sufficient to build a human being from a single cell.
when the genome project was started in 1990, we knew very little of that information. we had little snippets here and there of dna information, but the whole thing loomed in front of us almost like an impossible task because our technology was nowhere near up to the ability to read that number of letters in any kind of measurable time. david: so why is a person watching this or any human being better off because we have mapped the human genome? dr. collins: there are many questions about that. the whole thing got finished in 2003. there were some silly comments about, ok, medicine will be transformed in the next two weeks because of this. of course not. 6 billion letters that you don't really know the language, it is going to take a while to figure it out. what has happened now, over those last 14 years since then, has been transformative in medicine and particularly in cancer. cancer now, if you develop that terrible disease, you want to know exactly what misspellings have happened in the genome of
those cancer cells that are causing those good cells to go bad, and that is a transforming capability that is now affordable because of the genome project and pretty much has changed everything in the way we approach the diagnosis and treatment of cancer. david: today, anybody can have their human genome mapped, is it for $1000 or less? dr. collins: a little bit less. david: have you had yours? dr. collins: i have not had the whole thing read out, but i had a sampling of it eight years ago. i was writing a book about personalized medicine and wanted to use myself as a guinea pig. so, yeah, i learned some things in the process of doing that about my own future risks that i found useful. one thing i did learn is that my risk of diabetes was substantially higher than the average person based on my genetic inheritance, and that was sort of a shock because that is not something that runs in my family, but my family are all lean, athletic people, so maybe they managed to avoid it. that was a point when i was not lean and athletic. i was kind of indulging in too
many muffins and honey buns and not doing any exercise, and i was getting chunky, and that was enough to motivate me to change all of that and lose 35 pounds and get an exercise program. i am a different person now than i would have been if i'd stayed on that path. david: muffins and honey buns are not healthy for you? is that what you are saying? dr. collins: they are not healthy for anybody, i'm afraid. david: how much longer do you think people really can keep increasing the longevity? dr. collins: if you look around 1900, the average lifespan in the united states was only your late 40's, so we have dramatically expanded that. is human life extendable beyond about age 100? it is not clear that if we don't tinker with biology that we will get much beyond that point because there does seem to be a program here of limited lifespan, and frankly evolution cares about that. you have to get one generation out of the way so the next one has its chance. ♪
♪ david: dr. collins, in addition to being the director of the nih, you also maintain your own lab at the nih in genetic research. dr. collins: particularly focused on diabetes, and interestingly enough, on aging. david: what am i looking at? dr. collins: this machine basically analyzes dna, and particularly looks at places where there are differences in your dna and mine, variation, because that is interesting stuff if you're trying to understand risks for something like diabetes. you see that flashing light? that spot there has dna in it from a person, and the flash is a laser. it basically blasts the dna into the gas phase, and then it
travels down a long tube in this mass spectrometer, and it is measured by is molecular weight, which can tell you what was the actual dna sequence. david: give me one or two examples of something where you funded it and it became a very -- became very helpful to the health of individuals. dr. collins: sure. there is a long, long list of examples. let's take what has happened with heart disease. heart disease death rates from heart attack are down by 70%. why is that? part of that is our funding something called the framingham study in massachusetts, which taught us what the risk factors are that you could interfere with. we did not know how important hypertension was and how critical it was to treat it until that came along. part of this is drugs -- statins, the most commonly prescribed drugs these days. why do we know about statins? it is because of basic science research done 30 years ago by nobel laureates brown and goldstein figuring out there was a critical pathway that controlled cholesterol and you could interfere with that with the development of a particular drug.
david: when humans emerged from caves 200,000 years ago or so, or homo sapiens emerged, the average life expectancy was 20. more or less. today it is more or less, in the developed world, the united states, maybe around 80, so we have increased our life expectancy by four times. how much longer do you think people really can keep increasing their longevity? dr. collins: so, much of that happened in the last hundred years. if you look at around 1900, average lifespan in the united states was late 40's, so we have dramatically extended that. is human life extendable beyond about age 100? it is not clear that if we don't tinker with biology, that we will get much beyond that point because there does seem to be a program here of limited lifespan, and frankly, evolution cares about that. you have to get one generation out of the way so the next one has its chance, but we are getting pretty smart about understanding what are the actual molecular steps in aging, and maybe, if we think it is a
good idea, we might figure out how to achieve that kind of extension by tinkering a bit with the biology. david: on heart disease, do you think it is possible to eliminate all heart problems completely by diet, exercise, and statins? dr. collins: heart disease has a strong genetic component. if you are somebody in a family that has heart disease, that is something that could apply to you. cholesterol is a big risk factor. if your cholesterol is above 200 and, increasingly, maybe even below that, reducing it reduces the likelihood of a heart attack, and so it is worth doing, so more and more people are getting this recommendation about statins. it is particularly important for somebody who has had a heart attack and does not want to have another one to get on a statin and manage their cholesterol very tightly. that is one of the reasons why people are living longer. david: what do you think is the single greatest health challenge the united states faces today? dr. collins: right now, it is the opioid crisis. i am spending a huge amount of my time working with the
director of the center of drug abuse. we have been to the white house several times and have a very strong effort underway to work with the private sector to develop and implement quickly nonaddictive painkillers because opioids are pretty effective for treating pain. we need something else, but something that's not going to kill people. we can speed that up, especially with help from the fda. if you look at what the current health crisis around us, that is number one. more people died of opioid overdoses than of car wrecks last year. just unbelievable the way this has come so quickly. david: five years from today or 50 years from today, what will this machine look like, and what will we know that we don't know today? dr. collins: five years from today, probably these machines will not be used much anymore because it will be so cheap to sequence the entire genome for maybe $100 that you would not bother to get subsets of the information. just do the whole thing, and it will be cheap and accurate. the information, five years from now, more and more people will
have had this done, their genome will be in their medical record. when they need a drug for some particular condition, the doctor will look at their dna and say, oh, is this the right dose for this person? or is it even the right drug for this person? the whole idea of correlating drug response with genetics is ripe for exploration. in five years, we will see a lot of that. 50 years from now, i suspect most babies will have their genome sequenced at the time of birth, and that will be a way in which it can be planned how to make sure they get the best possible nutrition and medical care that they need, and we will have used the information to prevent an awful lot of diseases. i hope alzheimer's disease will be something you read about in a history book at that point, and that cancer will be a rarity. that is not out of the question. we are on the path. david: there has been a discussion about designer babies. is that a dangerous thing or not? dr. collins: well, with this ability to do gene editing, people are talking about this.
i am uneasy about the idea that we are smart enough to actually manipulate our future children in this way, and most of the things that people talk about wanting to manipulate, like intelligence or athletic ability, are controlled by hundreds of different genes. the ability to actually do this accurately is not going to be very reliable. a lot of it is environment and child-rearing. i often imagine this yuppie couple who want to have a designer baby, so they dial in all the things they think will make this kid a musician, first chair in the orchestra, and going to be a quarterback on the football team, and they forget to do the child rearing, so they end up with a sullen 16-year-old who is smoking pot in his bedroom and never comes out. you have got to do that part, too. david: how have you transformed yourself from an atheist or agnostic to somebody who is a committed christian? dr. collins: i realized i was a scientist, i was supposed to make decisions about questions based on evidence, and i never really considered whether there might be evidence supporting the
♪ david: you also are a motorcycle enthusiast. dr. collins: i am. david: now, is that safe? dr. collins: no, it is not. david: as somebody who cares about your health, how do you justify that? dr. collins: yes, that has been a question asked regularly. david: i am not the first person who pointed that out? dr. collins: no, my mom started this. i became a motorcycle rider in college because it was a cheap way to get around. i stopped riding motorcycles when my kids were little because i did recognize the safety issues. david: you don't do it anymore? dr. collins: i do. i started again. david: oh. dr. collins: it is a wonderful ride. i ride my motorcycle to work many days. it is a harley davidson king classic. it is a beast, and it gives you a certain sense of enjoyment of life that is hard to come by other ways. david: let's talk about another part of your life. when you were younger, if not an atheist, then an agnostic. how did you transform yourself from being either an atheist or agnostic to somebody who is a committed christian? dr. collins: it does seem like an odd story, doesn't it?
growing up on the farm, my parents were not opposed to religion. they just did not think it was particularly relevant, so i had no religious background. i got to college, those conversations in the dorm about what did people believe. i did not think i believed in any of it. so i was an agnostic, but by the time i got to graduate school, i was shifting to being an atheist and i would not be too comfortable keeping quiet if somebody was talking about the supernatural. it is all about nature and how you study it and describe it. then i went to medical school, and that third year of medical school where you are thrust out on to the wards and are sitting at the bedside with wonderful people whose lives are under threat and many of whom are not going to survive, you realize your own thinking about life and death has been pretty unsophisticated compared to the reality of what these people are facing. i realized i was a scientist. i was supposed to make decisions about important questions based on evidence, and i never really considered whether there might be evidence supporting the idea
there really is a god. i just assumed the answer was no. and that was a bit unsettling, but it seemed like something i should not ignore, so i began sort of asking those people i knew who were believers, how can you do this without checking your brain at the church door? because isn't this just a perfect example of irrationality? they told me, no, there is a pretty profound rational basis for faith. you might try reading cs lewis. for starters. i had never heard much about cs lewis. picking up some of the things he had written, particularly mere christianity, made it clear to me, oh my gosh, there is a compelling, intellectual, rational basis for faith which i had totally missed and assumed did not exist. it took me a couple of years of fighting against that, trying to prove this was all wrong and that i could stick with my agnosticism, but ultimately i realized i couldn't, that it was so compelling.
then i had to figure out which of the ways of understanding god is going to be the one that i can make the most sense out of. and after many considerations of various faith traditions, ultimately the person of jesus appealed to me in a remarkable way as a historical figure, not a myth, who had answers to questions that i really needed answers for, and whose life, death, and resurrection seemed to be remarkably well documented. david: your view would be that what is in the bible is allegorical. it is not to be taken as absolute fact. in other words, the bible would say maybe the earth is a couple of thousand years old. scientists would say it's much older. 5 billion years old. how do you reconcile those two strands of thought? dr. collins: it is now the case that a lot of people are tripped up by what they interpret as a conflict between a literal interpretation of genesis one and two and what science teaches us very convincingly about the
age of the universe, almost 14 billion years, and the age of the earth, almost 5 billion years, but that idea that there is a conflict is a recent arrival on the scene. go back and read saint augustine in 400 a.d. he was obsessed with what genesis is really telling us about origins. he would have been the first to say that this literal interpretation of 24 hour days is absolutely unjustified based on the original language and the way in which the audience for the original genesis stories would have interpreted it. somehow we, particularly in the united states, over the course of the last 150 years have taken something that was clearly written in a way that had a lot of ambiguity and insisted that it had just one possible interpretation, so i wrote a book about a lot of this perceived conflict. for me, there never has been one between what i know as a scientist, where if you're going to asked me a question about nature, science is going to be the way to get the answer, but
also somebody who is interested in questions science can't answer, like is there a god and why am i here? david: so today, what kind of recommendation would you make to young people about what they should do with their careers, and have you ever thought given your brainpower that you could've gone into the private sector and made a great deal of money? dr. collins: it comes down to what is it that we all hope to do in that brief time we are on this planet? what are we going to assess our contribution by? and right now, i would say medical research is very much near the top of the list of opportunities that people have, because it is such an exciting time. we are making progress at a pace now that would have been unimaginable a few decades ago, and that is going to continue. if you want to spend your time, yeah, working hard, but feeling as if you made a contribution to help people who are suffering, this is a great way to do it. and money alone is probably not going to give you that same satisfaction. ♪
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